Other psychotherapies

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Fewer outcome studies are available regarding the efficacy of interpersonal therapy, behavioural therapy, or brief dynamic psychotherapy. Most data are available for interpersonal therapy. The first randomized study in depressed women (66> found that only antidepressant prevented relapse, whilst interpersonal therapy, started 6 weeks after acute amitriptyline had a significant effect on social functioning. In a later study (67) interpersonal therapy was as effective as amitriptyline in acute treatment of outpatient depression. The NIMH study(63> is the only one that has compared interpersonal therapy with a pill-placebo control. Interpersonal therapy was nearest to the effectiveness of imipramine but a little weaker.

Few acute controlled trials of other therapies have been published. Two large-scale studies of individual behavioural therapy are available. In a comparison of behavioural therapy with insight-orientated therapy, antidepressant drugs, and relaxation, the behavioural approach was more effective than insight-orientated therapy (which tended to fair worst overall), but differences between treatments had largely disappeared at 3 months' follow-up. (68> Hersen et al.(69) randomly allocated 125 depressed females to antidepressant drug treatment, social skills training plus antidepressants, social skills training plus placebo or dynamic therapy plus placebo, and found similar outcome in all groups.

Few high-quality studies exist on marital and family models of psychotherapy. It is clear that cognitive therapy, interpersonal therapy, and brief dynamic psychotherapy can be applied to families, groups or couples, but the only published randomized controlled trials on marital therapy mainly draw on behavioural approaches. For example, O'Leary and Beach70 demonstrated that behavioural marital therapy or cognitive therapy were both more effective than waiting-list controls in treating women with depression or dysthymia. Furthermore, Jacobson et al.(71) demonstrated an advantage for behavioural marital therapy over cognitive therapy in depressed individuals with marital discord.

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